No, Misc.1002/2006/CGHS(R&H)/ CGHS (P) Government of India Ministry of Health & Family Welfare Department of Health & Family Welfare Nirman Bhawan, New Deihi Dated the 12” September, 2007 OFFICE MEMORANDUM Subject: Revision of Rates and quidelines for various Coronary Stents for CGHS/CS(MA) beneficiaries. The undersigned is directed to invite attention to the Office Memorandum, No. 9005/2003/R&H/CGHS/CGHS (P) dated 1° August, 2005, of the Ministry of Health & Family Welfare, vide which rates for different types stents were revised and to convey approval of Ministry for revised rates and guidelines for Coronary Stents for reimbursement to beneficiaries under CGHS and under Central Services (Medical Attendance) Rules, 1944. 2 The following Coronary Stents are approved for reimbursement to beneficiaries under CGHS and under Central Services (Medical Attendance) Rules, 1944, as per the ceiling rates given below: Name of Drug Eluting Stent Revised Ceiling Rate s. No. (DES) / Bare Metal Stent _ 1. | Cypher Stent . Rs. 95,000/- + VAT 2. | Taxus Stent Rs. 67,300/- + VAT 3._| Endeavor Rs. 85,000/- + VAT 4._| Xience VEECSS Rs. 95,000/- +VAT 5__| Yukon Choice Rs. 55,000/- + VAT 6__| Bare Metal Stent Rs. 50,000/- ( all inclusive) Reimbursement to beneficiaries or to empanelled hospitals (in case of pensioner CGHS beneficiaries, who are not to be charged by the hospital) shall be limited to ceiling rate or actual cost, whichever may be less. 3. A maximum of three Coronary Stents shall be permitted on the advice of Government Specialist, of which not more than two shall be of Drug Eluting Stents. However, DES shall be permitted only for patients where re-stenosis will involve high risk to patient’s life, i.e. (a )Osteal / Proximal LAD lesions aw)(b) Stenosis of a Coronary artery , which is giving collaterals to another blocked artery , thus supplying a large area of myocardium. (c )Stenting of restenotic lesions after previous angioplasty. Permission shall be granted as per laid down procedure 4 If a beneficiary under CGHS or under Central Services (Medical Attendance) Rules, 1944, has been implanted by any other non-approved drug coated stent or a drug eluting stent is implanted in conditions other than those mentioned above reimbursement shall be limited to the cost of Bare metal stent. If a non-approved drug eluting stent is implanted or a drug eluting stent is implanted in conditions other than those mentioned above in an empanelled hospital and no written informed consent was obtained from the beneficiary, that he / she would bear the difference in cost between the DES and Bare Metal Stent, and the hospital has charged this amount from the beneficiary, the additional amount shall be deducted from the pending bills of hospitals and shall be paid to the beneficiary. 5. It is essential for the empanelled hospitals to quote the Batch number when a coronary stent of any type (Ordinary metal / Drug Eluting Stent) is implanted in the case of a beneficiary under CGHS or under Central Services (Medical Attendance) Rules, 1944. In addition to this, the outer pouch of the Stent packet along with the sticker on it on which details of the stent are printed shall also be enclosed with the medical bill for claiming reimbursement from the Government. In case the private empanelled hospital has not given the batch number and /or outer pouch of the stent(s) in a particular case, the beneficiary is required to obtain the same from the hospital before the CGHS / concerned department, as the case may be, finally settles the claim for reimbursement. 6. These orders shall supersede this Ministry's Office Memorandum, No. 9005/ 2003/ R&H/CGHS/CGHS(P) dated 1* August, 2005, on the same subject and shall come into force from the date of issue. 7. This issues with the concurrence of Finance Division vide Dy. No 4902/07/IFD dated the 11"" September, 2007. Deputy Secretary to the Goverriment of India (Tel: 2306 3483) To 1 All Ministries / Departments of Government of india. 2. Director General of Health Services.aid LOND 13. 14, 415. 16, 17. 18. 19, 20. 21. 22 23. Director, CGHS. All Additional / Joint / Deputy Directors of CGHS (as per address list). Registrar, Supreme Court of India, New Delhi. / High Court of Delhi, Sher Shah Road, New Delhi 110 003 UPSC, New Delhi Lok Sabha Secretariat, New Delhi Rajya Sabha Secretariat., New Delhi Shri U. M. Purohit, Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi 110001 All Officers / Sections / Desks in the Ministry of Health & Family Welfare. MS Section, Ministry of Health & Family Welfare Comptroller & Auditor General of India, 10, Bahadur Shah Zafar Marg, New Delhi 110 002 Mis Johnson & Johnson Limited, 30 Forjett Street, Mumbai 400 036 Mis Boston Scientific Int’! BV, 100A, The Capital Court, Olof Palme Marg, Munirka, New Delhi 110 067 Mis India Medtronic Pvt. Ltd., 201-202, Plot 14, Local Shopping Complex, Kalkaji, New Delhi 110 019 Ms Lancer Medical Technology Pvt. Ltd., E-30, G. |. D. C., Electronics Estate, Sector 26, Gandhinagar 382 044, Gujarat. M/s Advance Therapeutics Pvt. Ltd, 411 Arunachal, 19 Barakhamba Road, New Delhi 110 001 MIS Abbott Health Care Pvt. Ltd., Office Floor, Crowne Plaza Surya, New Friends Colony, New Delhi 110 025 Copy to Technical Director, NIC, with the request that the Office Memorandum be uploaded on the website of CGHS. Swamy Publishers (P) Ltd., P. B. No.2468, R. A. Puram, Chennai- 600028. Swamy Publishers (P) Ltd., 4855, 24, Ansari Road, Near Sanjeevan Hospital, Daryaganj, New Delhi - 110002. Office Order folder Guard File \ Ae? (R. Ravi) Deputy Secretary to Government of India